Primigravida presents at 36 weeks of gestation with complaint of preterm premature rupture of membranes or leaking per vaginum and the following presentation. Management to be followed is?
**Core Concept**
Preterm premature rupture of membranes (PPROM) is a condition where the membranes surrounding the fetus rupture before 37 weeks of gestation. The management of PPROM involves a careful balance between the risks of preterm delivery and the risks of continuing the pregnancy in the presence of infection.
**Why the Correct Answer is Right**
In a primigravida at 36 weeks of gestation with PPROM, the primary concern is the risk of chorioamnionitis and fetal infection. Corticosteroids are administered to promote fetal lung maturity in anticipation of preterm delivery. However, since the fetal lungs are mature at 36 weeks, and the primary concern is infection, the most appropriate management would be to administer antibiotics to prevent or treat infection, and prepare for delivery as soon as possible.
**Why Each Wrong Option is Incorrect**
**Option A:** Corticosteroids alone may not be sufficient to address the risk of chorioamnionitis and fetal infection.
**Option B:** Expectant management with observation alone may not be appropriate, as the risk of infection is high at this gestational age.
**Option C:** Induction of labor without antibiotic prophylaxis would increase the risk of chorioamnionitis and fetal infection.
**Clinical Pearl / High-Yield Fact**
In cases of PPROM, the American College of Obstetricians and Gynecologists (ACOG) recommends that antibiotic prophylaxis be administered to women with PPROM at or before 37 weeks of gestation to reduce the risk of chorioamnionitis.
**Correct Answer: D.**